Counselor Burnout: Risks and Concerns

Counselor-of-the-Year awards and other such awards are very common in most alcohol and drug abuse treatment agencies. Most people are intuitively aware of what it takes to receive such an award. Characteristics such as commitment, empathy, motivation, dedication, concern for others, exceptional skills, and the ability to go above and beyond expectations are often cited as qualities of those who receive these awards, but how do they do it? What keeps them at such a high degree of effectiveness and a high level of job satisfaction? On the other hand, can these qualities be lost, and if so, what contributes to their loss?

Last year I attended an award ceremony for a large agency in Oklahoma and I was impressed by the Counselor-of-the-Year presentation and the response of the recipient. When the winner of the award was announced there was an immediate standing ovation for him. It was obvious that not only was the award well deserved, but also he was held in very high esteem by his fellow clinicians and the entire staff of the agency. His remarks were very gracious, insightful, and humble. What I remember the most were his comments about being a counselor of the year and that he said to his fellow counselors that when you help that one individual to become clean and sober, that you truly went the extra distance, and made a significant impact on that person’s life then for that person you are the counselor of the year. 

Over the past decade there have been many articles and research studies about the risk for burnout for staff and clinicians in alcohol and drug abuse treatment agencies. A new survey released last month by Health eCareers indicated several serious concerns about recruiting and maintaining quality staff in health care services including alcohol and drug abuse treatment agencies (“2015 healthcare,” 2015). They indicate that over the next ten years the demand for health care services will increase dramatically. This is also true for the demand for alcohol and drug abuse counselors, according to the US Department of Labor, which indicates a significant increase by the year 2020 (US Department of Labor, 2014). At risk will be the gap between supply and demand. According to the Health eCareers survey, the biggest challenge for agencies will be the ability to not only attract qualified people, but also to retain them. The solution to the potential problem is retention. The greatest threat to retention is personnel burnout.

Therefore, the coming challenge facing most addiction treatment programs is not limited to successful outcomes of clients, but rather avoiding clinical and other staff personnel burnout.  The success for a client and therapist is always based on a healthy therapeutic alliance. It is the foundation upon which everything moves forward. The well-prepared counselor knows this, but she or he also knows the importance of being well prepared day after day. This success depends on a counselor who is well motivated, well trained with contemporary theory and techniques, who has an overall sense of job satisfaction and a belief that she or he can make a difference in other peoples’ lives. The greatest threat to the counselor is not the difficulty of the client, but in avoiding counselor burnout. Additionally, the supporting staff members of any treatment agency often experience some of the same risks for burnout. 

The threat of burnout in the addiction fields can come from many sources. Currently, there are great changes occurring in the alcohol and drug abuse treatment industry. For one, the demand for treatment programs and more beds for clients is growing and at an all-time high (no pun intended). Two new populations are coming more and more to treatment. The first population is adolescents or young adults who are entering treatment at younger and younger ages. The other group is the increasing amount of older adults or “baby-boomers” that bring not only addiction to illegal drugs, but also prescription drugs. Both of these populations bring additional challenges for the clinicians. 

The Affordable Care Act might bring more clients into treatment as well. The emergence of understanding process addictions and their overlap with chemical addictions are occurring more frequently. It is also true for the overlap with mental disorders and behavioral disorders often associated with addictions. Understanding the emergence and frequency of medication-assisted treatment will challenge many therapists. Appreciating and applying gender and cultural considerations in treatment will be paramount to meeting the needs of our growing population seeking help for addiction. In other words, there is and will continue to be more and more demands on those working in the alcohol and drug field.

Although burnout is a threat for many clinicians, we must remember that in order to burnout you must have been on fire at one time. The many positive characteristics that I mentioned earlier for successful counselors must have been present at one time. Without self-care and understanding the risk factors for burnout, counselors can lose what made them great without knowing what has happened. According to Skovholt and Trotter-Madison, one of the things that makes being a good counselor difficult is that the counselor walks the difficult line between bonding and separating with clients (2010). Skovholt describes what he calls “the cycle of caring,” which is a circular process that occurs between the counselor and the client. This occurs in four phases.

1. Empathic attachment phase—this is the therapeutic process whereby the counselor forms a bond with the client based on trust and communication.
2. Active involvement phase—the counselor engages in the client’s problems and works with him or her.
3. Felt separation phase—the relationship with the client ends and the counselor then reaffirms her or his own identity and separation.
4. Re-creation phase—the counselor begins to reenergize the self in order to enthusiastically begin the cycle of bonding and separation with the next client.

The process of bonding and separation is no easy task and along the way there are risk factors for burnout. Some of the most common risk factors for counselors are:

• Giving too much emotional support for too long
• Trying to achieve too much for too long
• Exceptionally high standards make it difficult to delegate to others
• Intense and continued pressure for too long
• Inability to say “no” to too many additional demands
• Lack of success with clients
• Lack of positive feedback about a client’s success either from the client or coworkers
• Overworked and too many nontherapist tasks
• A client’s problems raise the counselor’s problems

These are just a few of the risk factors for counselors, but they all indicate a need to understand the demands of being an effective counselor and to promote and provide a mechanism for self-care within alcohol and drug abuse treatment programs. When we ask people to share parts of their lives in order to help others with parts of theirs, we need to remember that we are taking something from the healer and it needs to be replaced. Burnout will always be a risk when we give of ourselves to other people, but those who find professional and personal balance in their lives do no run out of their abilities to give. Counselors who are truly appreciated and organizationally nurtured by their agencies and others are all capable of being counselors-of-the-year.  

“2015 healthcare recruiting trends survey.” (2015). Retrieved from http://news.healthecareers.com/wp-content/uploads/2015/02/RecruitingTrends2015-DOWNLOAD.pdf

Skovholt, T. M., & Trotter-Mathison, M. J. (2010) The resilient practitioner (2nd ed.). New York, NY: Routledge

US Department of Labor. (2014). Occupational outlook handbook: substance abuse and behavioral disorder counselors. Retrieved from http://www.bls.gov/ooh/community-and-social-service/substance-abuse-and-behavioral-disorder-counselors.htm